There has been a huge shift in awareness in recent years of what constitutes a humane environment for the most vulnerable, generally elderly, individuals. The traditional “retirement home design ” or skilled nursing facility characterized by many residents, lack of privacy and little opportunity for control or choice has given way to small scale environments that are called households or small house settings. These have 9 to 12 residents who live in private rooms clustered around a family kitchen, living room and other shared spaces that have a truly residential appearance. Access to the outdoors and a garden are often present. Emphasis on meeting residents' individual needs and preferences is fundamental to maintaining dignity. Evidence-based research should be employed in any senior living environment whether in nursing home design, assisted living design or congregate care design to promote a high level of safety and comfort.